Four months ago, the unemployed salesclerk's son was born with a heart blockage. Doctors told Hajaj that the baby's only hope was transfer to a Jerusalem hospital because Gaza lacked a pediatric surgery unit.

While his son, Mohamed, fought to breathe on a ventilator, Hajaj spent a week gathering the transfer documents needed under Israel's strict border rules. Then there was another agonizing week, watching as his son's tiny body began to bloat as he waited for an answer.

Approval finally came — two days after Mohamed died.

"Why should it take so long for a days-old innocent baby with such a serious problem?" asked Hajaj, 37, in his Gaza City home, clutching the medical records and authorization form that came too late. "No crisis? I lost my son. We're not treated like human beings. Let me ask you: Would Israelis accept to live under these conditions?"

In the aftermath of the deadly May 31 commando raid on an aid supply flotilla, Israel's 3-year-old blockade of Gaza is coming under unprecedented scrutiny. In addition to the naval cordon, Israel and Egypt maintain tight restrictions on the movement of goods and people over their borders, stopping everything from vinegar to the terminally ill.

Israeli officials defend their policy as necessary to prevent rockets and other weapons from reaching Hamas, the Palestinian armed movement that controls Gaza and refuses to recognize Israel's right to exist. They say the reports of dire conditions in Gaza are exaggerated.

"There is no humanitarian crisis in Gaza," Israeli Prime Minister Benjamin Netanyahu said recently in a televised address.

Experts say it's not so simple. Although it's true that there is no hunger and there are no epidemics, the situation in Gaza defies usual categorization, aid officials say.

"Look, it's not like sub-Saharan Africa," said Chris Gunness, spokesman for the United Nations Relief and Works Agency, which assists Palestinian refugees. "We are not talking about a natural disaster or famine caused by failed rains. But Gaza is a political crisis with grave human consequences."

So although some can argue that Gaza's mortality rates are steadily improving, others could note that more Gazans died during Israel's 22-day military assault 18 months ago than civilians were killed in Darfur during all of 2009.

Acute malnutrition in Gaza is well below the "emergency" threshold. But at the same time, a higher percentage of Gazans are dependent on food aid than is true of Somalis.

Health officials report no serious problems with cholera, measles or diarrhea, yet 90% of Gaza's water is so polluted that it's undrinkable, and on average two patients die every month waiting for Israeli permits to leave Gaza for treatment, according to the World Health Organization.

"It's not the kind of disaster that you might see in other places," said Mahmud Daher, head of WHO's Gaza office. "But it's always on the edge of a crisis. And without the help of the international community, it would be a crisis."

Passing through the half-mile Erez checkpoint and emerging into Gaza, the contrast could hardly be more stark. In Israel, there are shopping malls and traffic lights. In Gaza, donkey carts and herds of goats cross the road. Young boys pick through the debris of bombed-out buildings to salvage construction materials.

In Gaza City, sidewalks are filled with idle, unemployed men and lonely shopkeepers, drinking tea and smoking, waiting for customers who rarely come.

At the same time, a certain normality has returned. The stores are stocked with food, electronics, furniture and clothin, much of it smuggled from Egypt through illegal tunnels. Cafes offer espresso and croissants. A shipment of 2010 Hyundai sedans recently arrived. Now that school is out for the summer, families are flocking to the beach to eat ice cream and barbecue.

At Shifa Hospital, Director-General Hussein Ashour says the situation is anything but normal at his overcrowded public facility, which is struggling to stay open amid Israeli and Egyptian restrictions on the importation of equipment and drugs.

His MRI hasn't worked in a year because he can't get a spare part. A replacement CT-scan machine is stuck in the West Bank. There are chronic shortages of medical dyes used for diagnosing cancer, clotting drugs for hemophiliacs and batteries for dialysis machines.

"A one-month supply of anything here is a real luxury," Ashour said.

Waiting lists for nonemergency operations to treat hernias or remove tonsils are 18 months long. And the list of procedures that can't be done in Gaza is growing, including heart surgery, radiation treatment and bone-marrow transplants.

Through Ashour's office window, he can see the half-built pediatric hospital across the street. Construction halted because there was no cement.

Israeli officials insist that they work hard to evaluate humanitarian conditions in Gaza to prevent a crisis.

They defend the restrictions, saying goods that are banned or restricted come from an internationally accepted list of so-called "dual use" products, including fabric, X-ray machines and some medical supplies.

"There are a lot of things that can be used for terror," said Maj. Guy Inbar, a military spokesman.

He said medical transfers for patients are approved 80% of the time and that when they are rejected or delayed it is usually for security reasons.

In the case of Hajaj's infant son, Inbar blamed Palestinian authorities for not emphasizing that the case was urgent.

Nevertheless, Inbar said, Israel has begun to review its policies with an eye toward relaxing them, particularly after the international outrage over Israel's killing of nine passengers on the aid flotilla attempting to break its blockade. Last week, Israeli said it would permit, for the first time, jam and cookiesand other snack foods into Gaza.

Israel says the tough rules on Gazans are a way of isolating Hamas, which Israel labels as a terrorist organization. The group won Palestinian elections in 2006 and seized control of Gaza the following year.

Israel's blockade came in response to the 2006 capture of soldier Gilad Shalit and Hamas rocket fire at Israeli towns. Shalit is still being held in Gaza.

Egypt also closed its border with Gaza, partly under pressure from Israel and partly because it was concerned about infiltration by Hamas extremists. After the flotilla raid, it eased the restrictions to allow some traffic through.

Since the blockade began, Gaza's already weak economy has sunk even further. Two-thirds of Gazans live in poverty and about 40% are unemployed.

More than 95% of Gaza's factories and industries have shut down, a recent report says. The once-thriving fishing industry is so crippled by the naval blockade that the coastal enclave must import seafood.

"The goal is to exert pressure on Hamas by dismantling the economy," said Sari Bashi, head of Gisha, an Israeli group that advocates for the Palestinians in Gaza. "We call it collective punishment."

For construction worker Fawzi abu Jarad, 42, business should be booming, given that thousands of homes were destroyed during the late 2008-early 2009 Israeli offensive. But the restrictions on the importation of cement have left him out of work.

In 2007, his $160-a-month paycheck, though meager, enabled him to put food on the table and allowed for an occasional splurge, such as taking his kids to the beach.

Now the family of eight lives in one small room. They survive off three-month supplies of flour and other basic food items distributed by the United Nations.

"I can't even feed my family anymore," Abu Jared said. "I appreciate the aid, but I don't want aid. I want to work. It's a miserable situation. There is no dignity."

Originaly Published By Edmund Sanders, Los Angeles Times
edmund.sanders@latimes.com